Appropriate Screening Tests to Assess Post-COVID-19 Cognitive Dysfunction in Aeromedical Settings, 2025, Beka et al.

SNT Gatchaman

SNT Gatchaman

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Appropriate Screening Tests to Assess Post-COVID-19 Cognitive Dysfunction in Aeromedical Settings
Beka SG, Griffiths RF, Myers JA, Skirrow PM

INTRODUCTION
Post-COVID-19, 10–20% of individuals may experience long-term symptoms (some having cognitive deficits), even after mild or nonsymptomatic infection. A sufficiently sensitive screening test of cognitive function, based on the typical cognitive effects of COVID-19 and skills considered most relevant to pilot performance, would be highly beneficial to be used alongside other performance checks. This study aimed to identify appropriate screening tests for post-COVID-19 cognitive dysfunction.

METHODS
Initially, a systematic search and narrative review identified 13 screening tools that are likely to be effective in screening pilots for post-COVID-19 neurocognitive impairment. Following a more in-depth evaluation of the identified tools, five tests including the Trail Making Test, Symbol Digit Modalities Test, Stroop Color Word Test, Psychomotor Vigilance Test, and Paced Auditory Serial Addition Test were chosen for a Delphi evaluation exercise. A two-round modified Delphi process was undertaken with international aviation medicine and psychology experts to obtain a consensus on which of the identified tests would be appropriate to screen for cognitive dysfunction in pilots.

RESULTS
Based on evaluation of literature review findings and Delphi consultation with subject matter experts, the Trail Making Test and Symbol Digit Modalities Test were identified as quick and suitable screening tests likely to detect post-COVID-19 cognitive dysfunction.

DISCUSSION
These tools are objective, have good utility, are available in multiple versions, and assess cognitive abilities relevant to pilot performance. Their use for screening in aeromedical examinations would be further supported by confirming their ability to reliably detect neurocognitive impacts associated with COVID-19.

Link | Aerospace Medicine and Human Performance [Paywall]
 
How interesting.

Have any of you watched Nathan Fielder's The Reheasal Season 2? It won't be to everyone's taste, but I enjoyed it. In that Season 2, Nathan looks into why planes crashed, reading black box transcripts, and decided that a big part of it was poor communication between the pilots. He actually got his pilot's licence from scratch, then did the training to become a licensed pilot of big passenger planes. He constructed a replica airport terminal, and did all sorts of role playing.
He even co-piloted a plane with 200 or so people on it in the last episode (and then went on to have a side hustle in flying planes after the show finished).

And.while it is often hilarious, it is also chilling in many ways. One way was in revealing how much pressure pilots are under to not show any sign of weakness. Pilots with depression have to think hard about admitting to it and getting help and support, because, well you wouldn't want someone who might be suicidal to be in charge of a plane with hundreds of people on it, would you? But of course, the depressed pilot who doesn't tell anyone is still in charge of a plane with hundreds of people on it, it's just that they have no support or specific monitoring....

I know how hard people with ME/CFS will often try to keep working, and to convince themselves and others that they are fine. It seems to me that there are quite a range of occupations where you might want to have people having regular cognitive assessments and some sort of good safety net so that people can take a break before they do something disastrous.

I don't think cognitive monitoring can really be left to the person's colleagues. Nathan Fielder's show showed that. Re-enactments of the black box transcripts showed that the co-pilots would sit quiet even as the chief pilots made bad decisions and crashed the plane. I can imagine that situation in some surgical teams, especially in some countries too. Who is going to be the one to say that the surgeon doesn't really seem to be functioning well? I wonder how a surgeon, who probably has rolled their eyes at hysterical patients along with their colleagues and is a strong believer in just working hard and getting on with things, copes when they get Long Covid?
 
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Abstract said:
DISCUSSION
These tools are objective, have good utility, are available in multiple versions, and assess cognitive abilities relevant to pilot performance. Their use for screening in aeromedical examinations would be further supported by confirming their ability to reliably detect neurocognitive impacts associated with COVID-19.
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They say the tools have good utility in testing for (some of the) cognitive abilities a pilot needs. But, they also note that they aren't sure if they have good utility when it comes to detecting the impacts of Long Covid on cognition.

Perhaps the prospect of incapacitated pilots will be enough for more funding to develop some good cognitive tests that really do work for Long Covid/ME/CFS.

A difficulty is capturing the fluctuation. A person may be able to rest up for days before a test, in order to pass it. But, their performance may be completely different, even compared to their colleagues, after several long days of work.
 
SNT Gatchaman said:
Particularly given today's news that the Air India crash preliminary report indicates it may have been caused by one of the pilots deliberately cutting the fuel to both engines.
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“in the cockpit voice recording, one of the pilots is heard asking the other why did he cut off”, referring to the fuel switch.

“The other pilot responded that he did not do so.”
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When I read that I immediately wondered whether one of the pilots might be suffering Long Covid brain fog.
 
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